Laserfiche WebLink
!' NAMC/A17U1 Indid/e NA'r10UAI P0$ I III ANT nn,r 1 [:I IMII/A I IUIJ 1Y'.11 formA�(J <br /> u/LocationifdlJJc DISCHARGE MON ING REPORT /1MIR) FormA R40-0004 <br /> `11LL—lwL!tULhkLN1--L.u"--L-.1�.LU----_----- L': _ 17_192 F ,� FIN A Approve/expires 9.30-BS <br /> 5 tCT 11 <C1R=10YR24HR <br /> (..�,p�•( [�,�_------f 17 '�L�— PERMIT NUMBER DISCHARGE NUMBER <br /> `----------- MONITORING PERIOD <br /> '-------- YEAR MO DAY YEAR MO DAY �A 1.� <br /> IN -- FROM TO M 11VUk <br /> Ru 120-21) (22-23J (24-25/ (26-27) (28-29) (30.31) NOTE: Read instructions before completing this form. <br /> PARAMETER <br /> (3 Card Only) QUANTITY OR LOADING (4 Card Only) QUALITY OR CONCENTRATION NO FREQUENCY(46.53) (54-6/) (38.45) (46-53) (54-61) or <br /> SAMPLE <br /> (3Z•371 EX ANALYSIS TYPE r <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 62.63 (64-68J (69-70J , <br /> rJ`1U GFt```ASE SAMPLE <br /> MEASUREMENT <br /> L _ <br /> 1 0 PERMIT t R SPURT `*.* ES=lN KtRYV1SUAl. . <br /> REQUIREMENT <br /> �� <br /> SAMPLE DAILY MX <br /> �^� ^� �I 1 <br /> MEASUREMENT i <br /> PERMIT I 4. <br /> �_ <br /> REQUIREMENT 1 <br /> SAMPLE f <br /> MEASUREMENT <br /> PERMIT - <br /> REQUIREMENT f <br /> SAMPLE <br /> MEASUREMENT <br /> I E <br /> PERMIT --' <br /> I REQUIREMENT I <br /> SAMPLE <br /> I <br /> MEASUREMENT <br /> PERMIT — <br /> REQUIREMENT <br /> SAMPLE i <br /> MEASUREMENT f <br /> I <br /> PERMIT - - <br /> REQUIREMENT �— - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> s I <br /> REQUIREMENT <br /> rLE PRINCIPAL EXECUTIVE OFFICER cianPr uNDEw ErvwLrr nr- LAw THAT I HAVE PERSONALLY ex MINm TELEPHONE D A T E <br /> ANO AM FAMILIAR wITH 111G INFORMATION SUBMITT60 HCREIN ANDABASiD <br /> ON MY INDUIRY OF TIIOSfi IrvO1VI0UALf IMMEDIATELY RESPON.IB LH POR <br /> OBTAINING THi INFORry A}IUN, 1 HELIH VE Hi SUB MITTHO INFORMATION <br /> {{{�� �v)✓�ttl J/1 IS TRUE, ACCVRA Tfi A U COMFLHTE. 1 AMrAWARI THAT THHRH A S,I- <br /> TA.., <br /> NIPICANT FENALTIfiB FOR SUU MITTINO _T. INFORMATION, IN CLU A rV V <br /> - rHe Fo s4IBlurr of FInH wnD IM VRIsoNMervr. see n u.s.c. § rool wrvo o \T\ <br /> » S.C. § nu, SIGNATURE OF PRINCIPAL EX CUTIVE <br /> -.�. (Penalties under Neese statutes may include fines up to$/0,000 <br /> OFFICER OR AUTHORIZED AGENT ._ _ _ •_,__-_ <br /> TYPED OR PRINTED _ _ _ and/or ntaxmntm inytrrsonmcnt of bc61'rcn.6_momhs.m[d5years/ - ARIOE ,1. <br /> NUMBER YEAR MO DAY <br /> r AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br /> i <br /> DISCHARGE OCCURS RPT W D1 :CFiKGtw jN YUUK DMR , <br /> 0 3320.1 (Rev. 1U-7'!1 UN PR TItL SUPPLY IS EXHAUSTED.0 BE (ItLPLAC ES EPA FORM T-40 WHIT:11 MAY NOT l3E USE D.I PAGE OF <br /> 0057b/98;A86-1527 2 ;z <br />